"An Angel Baby's Cuddle Sent To A Family In Need"

This form will only work on Google Chrome on PC. Please make sure you on a laptop or desktop computer and Download Google Chrome for PC

  • Home
  • Hospital Program - Order Form

Hospital Program Order Form

Fill out the form below for your Molly Bear order to be placed. Your Molly Bear will ship within 48 hours. Molly Bears will NOT share or sell your information! Fill in as many fields as possible.

Personal Information


Please let us know your first name.

Please let us know your last name.

Please Enter Your Phone Number With Area Code

Invalid email address.

Shipping Information


Please Provide Your Address

Please Provide Your City

Please Choose Your State

Please Provide Your Zip Code

Information About Your Angel Baby



Invalid Input
Angels Birthday:
(Date of Birth)
/ /
You must choose a past date.
Angelversary Date:
(Date of Passing)
/ /
You must choose a past date.

Invalid Input
Please provide the weight of your angel in pounds and ounces. Please convert any fraction of pounds directly to ounces.

Invalid Input
For Example: 1.5 pounds DOES NOT equal 1 pound and 5 ounces, this equals 1 pound and 8 ounces.
Click Here For a Weight Calculator

Personalization Requests

It is important to remember that all special requests are not guaranteed. Our absolute guarantee is that your Molly Bear will match the weight you have provided us, and we promise the weight of your angel will be comforting in your arms.
We understand all too well that when our angels are no longer with us seemingly small details to some people can become big details to us. For this reason, we want to provide a personalized bear that is not only comforting but is also meaningful to you. Our team is all volunteers. Some of the requests that have been given to us are not possible for several reasons. Our team will do its best to match up to 2 of your requests.


Invalid Input
1. Please tell us what specific colors or patterns you associate with your angel. (I.E. Baby Blue, Purple, Royal Blue Chevron pattern, pastel polka dots, etc.)

Please enter a preferred color, pattern or style. If None, enter "None".
2. Please tell us if there was a specific theme you associate with your angel. (I.E. Butterflies, Zoo Animals, Nursery decorations, a Nickname, etc.)

Please enter a preferred theme or reference. If None, enter "None".
3. Please share any items that you do NOT want on your bear. (I.E. Nothing Religious, Please do not use a white bear, I don't like baby animals, etc.)

Please let us know if you want to exclude any items on your Molly Bear. If None, enter "None".
4. If you have a specific request, have seen a decor item, bear style or detail that you love, please list that information here.

If you do have any special requests or notes, please enter "NONE" (Limit 200 Characters)

Embroidery Options

Our volunteers are able to create personalized patches that include your angels name.
Would you like your Molly Bear to include your angel's name?

Please Choose an Embroidery Option

Please let us know your angels name for embroidery.

Order Form Agreement & Verification Code


You Must Agree To The Molly Bears Privacy Policy, Terms And Conditions Before Submitting Your Order!

Invalid Input



Invalid Input

If you encounter any problems with your voucher code, please be sure you are using an up- to-date Google Chrome browser on a laptop or desktop. If you still experience issues, or do not have a PC available to you, please Contact Us for assistance.

Molly Bears